Case:Nemesis
Nemesis BG Information Nemesis Log Book (excel format) December 17/18, 2005 Curve (excel format) November 12, 2005 Curve (excel format) September 17, 2005 Curve (excel format) August 28, 2005 Curve (excel format) August 15, 2005 Curve (excel format) Pictures of Nemesis and Kiwi September 2005 October 2005 Nemesis Hospital Stay (Pancreatitis) November 2005 Nemesis Eye Surgery November 2005 Kiwi November 2005 Christmas 2005 February 2006 January 2008 Nemesis History Nemesis was diagnosed with diabetes on July 27, 2005 after exhibiting behaviours that were not normal. These included sleeping in the sink, playing in water and just an overall sense of blah. Her vet requested that I start her on two units PZI (a bovine-based PZI available in Canada) twice a day (BID) and after a week to increase it to 3 units BID. No mention of a curve, glucose monitoring or anything. Luckily I found the Feline Diabetes Message BoardFeline Diabetes Message Board and learned valuable information about Feline Diabetes and how to best treat Nemesis. Nemesis was started on 1 unit of PZI BID and I learned how to hometest using a human glucometer (One Touch Ultra). Nemesis has been having re-occuring eye problems since September 2005. She has had multiple diagnosis of UveitisAnimaleyecare.net-Feline Uveitis in both her left and right eye as well as a corneal ulcer in her right eye. Nemesis was admitted to hospital at the beginning of October for ketones. She remained in hospital for one week (discharged half way through and brought back the same day). Upon release, she refused to eat and was brought back to the hospital for another 3 days (high liver values which could have possibly lead to fatty liver). Nemesis was switched to Lantus while in Hospital for ketones. At that time we also switched vets as our old vet had told us we had "jumped the gun" by taking Nemesis to the hospital when she wasn't showing any symptoms of ketoacidosis. Our old vet believed in a very reactive approach to treating diabetes. Our new vet(s) believe in a very proactive approach to treating diabetes. They are very encouraging and supportive of my home testing and research. Nemesis spent 8 days in hospital due to a suspected pancreatitis attack in November of 2005. Upon returning home, her food was switched to the lower fat & carb/higher protein varities of Fancy Feast (specifically Grilled Chicken and Grilled Beef). During her hospital stay, her Lantus dose was increased to 2 units BID. She is doing much better and happily eating on her own since coming back home. Nemesis is now up to 3 units Lantus BID, and showing remarkable improvement in her BG numbers after only a couple of days at the new dose. I have also been supplementing with Humulin R boosters as needed for those extra high days. References January 2006 After spending much of Christmas working with R boosters to keep Nemesis in better numbers as much as possible, things took a positive change after making a change to her food. Because of Nem's suspected pancreatitis, she needs to be on a low fat diet. The Fancy Feast flavours I was feeding her was causing horrific diarrhea. In an attempt to find a new food, a fellow FDMB member pointed me in the direction of Merrick. Since switching Nemesis and Kiwi to Merrick food on January 9, her diarrhea has cleared up and her boosters have dwindled down to almost nothing. She is currently on 4.5 units of Lantus BID, and showing beautiful drops into normal numbers. She is also acting so much happier. She is playing and chasing Kiwi, her PU/PD has drastically reduced. February 2006 Another bout with ketones and very high insulin resistance has prompted another change in insulin. After discovering that Levemir was now available in Canada, I brought in the information from the wiki and requested that Nemesis try that. As of February 26, 2006 Nemesis has been switched to Levemir. She was currently up to 5.5 units of Lantus with no noticeable drop in BG levels. Her PU/PD had increased and she is now getting 100 mls of fluids at home each day. March 2006 Nemesis continues to stay on Levemir, without the addition of any boosters. She is currently on 3 units BID, but I suspect a raise may be needed. She has been staying on a dose between a 2.75 - 3.00 units for 2 weeks. A slight decrease from 3 units caused her PU/PD to increase. Her coat is still soft and luxurious, and her appetite is back. She is only getting fluids every few days now, because she doesn't appear dehydrated. She has been more playful lately, thinking that BG testing time is playtime. April 2006 Nemesis was very proud to be named wiki cat of the month for April. I have no doubt it will swell her head to twice its normal size. The latter part of April has proven to be AMAZING for Nemesis. After trying TID dosing during Easter, Nemesis has fallen into a beautiful routine of normal numbers for the majority of her cycle. This is maintained by combating her food spikes with a dose of R. Lately, both her R boosters and Levemir have been declining. Meaning she is needing less of both to maintain those beautiful numbers. This also means less and less sleep for me as I get nervous seeing her drop lower and lower. Overall, I have one very happy kitty. April 2006. May 2006 Nemesis is now tightly regulated on Levemir! Throughout the month of May her dose has dropped from 4 units Levemir BID and 2 units R at the beginning of May to 1.25 units Levemir and only the odd 0.5 units R. She has been a very happy cat. All symptoms of diabetes are gone. Even when she drops low, it seems to be easy to catch and low carb wet food takes care of it. January & February 2007 Nemesis still eats Merricks. Nemesis is still on a base does of Levemir (currently 2 units BID) and a sliding scale of Humulin R. She is doing very well, and I only test her at PS times. I also no longer keep a log book. If she is nothing else, she is extremely consistent. The highest I have seen her over the past two months was 15 (270) and she is usually at 10 - 8 (180 - 144) or lower at PS time. I have also discovered that with our regimine that I can delay or shoot early without any problems. For example, sometimes because I know I have to be somewhere, I shoot at + 10. Other times, because I have come home late from work, I shoot at + 14. It is probably due to her silly food spikes, but we continue to deal with them with R. January 2008 Been a while since I updated Nem's case study, so I will give you a brief synopsis of the last year. Nem on Levemir was so predictable that we reduced testing to only pre-shots. She stayed on Merricks, with the Levemir/R insulin. In late November, her glucose readings started to be off the wall. I am now testing her fairly often and aggressively increasing her doses until I can regain her tight regulation. Category:Booster cases Category:Difficult regulation cases Category:Feline cases Category:Female cases Category:Glucose toxicity cases Category:Humulin R cases Category:Ketoacidosis cases Category:Lantus cases Category:Levemir cases Category:Medium-carb diet cases Category:Pancreatitis cases Category:Other infection cases Category:Compounded PZI cases Category:Overlap cases Category:Tight Regulation cases Category:Feline female cases Category:Feline medium-carb cases Category:Regulated cases Category:Feline regulated cases Category:Feline tight regulation cases Category:Feline difficult regulation cases Category:Feline ketoacidosis cases Category:Feline other infection cases Category:Feline pancreatitis cases Category:Feline booster users Category:Feline glucose toxicity cases Category:Feline Levemir users